Five-Year Hospital Readmission After Coronary Artery Bypass Surgery and the Association With Off-Pump Surgery and Sex.
Five-Year Hospital Readmission After Coronary Artery Bypass Surgery and the Association With Off-Pump Surgery and Sex.
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DOI：
10.1161/jaha.122.028063
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发表时间：
2023-04-18
影响因子：
5.4
通讯作者：
Lamy, Andre
中科院分区：
文献类型：
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作者：
Dimagli, Arnaldo;Gaudino, Mario R.;An, Kevin R.;Olaria, Roberto Perezgrovas;Soletti, Giovanni, Jr.;Cancelli, Gianmarco;Harik, Lamia;Noiseux, Nicolas;Stevens, Louis-Mathieu;Lamy, Andre
关于冠状动脉旁路移植术后长期再入院及其与患者和手术特征的相关性的数据有限。我们旨在研究冠状动脉旁路移植术后5年的再入院率，特别关注性别和非体外循环手术的作用。我们对涉及4623例患者的CORONARY（冠状动脉旁路移植术[CABG]停泵或泵内血运重建）试验进行了事后分析。主要结局为全因再入院，次要结局为心脏再入院。使用考克斯模型研究结局与性别和非体外循环手术的相关性。使用灵活的全参数模型随时间推移研究性别的风险函数，并相应进行时间分段分析。计算Rho系数，以确定再入院与长期死亡率之间的相关性。中位随访时间为4.4年（四分位距，2.9-5.4年）。5年时全因再入院和心脏再入院的累积发生率分别为29.4%和8.2%。非体外循环手术与全因或心脏再入院无关。随着时间的推移，女性全因再入院的风险始终高于男性（风险比[HR]，1.21 [95% CI，1.04-1.40]; P=0.011）。时间分段分析证实，在前3年随访后，女性的全因再入院风险（HR，1.21 [95% CI，1.05-1.40]; P<0.001）和心脏再入院风险（HR，1.26 [95% CI，1.03-1.69]; P=0.033）较高。全因再入院与长期全因死亡率强相关（Rho，0.60 [95% CI，0.48-0.66]），而心脏再入院与长期心血管死亡率强相关（Rho，0.60 [95% CI，0.13-0.86]）。冠状动脉旁路移植术后5年的再入院率很高，女性更高，但非体外循环手术则不然。URL：http：//www.clinicaltrials.gov/;唯一标识符：NCT 00463294。
Limited data exist on long‐term readmission and its association with patient and procedural characteristics after coronary artery bypass grafting. We aimed to investigate 5‐year readmission after coronary artery bypass grafting and specifically focus on the role of sex and off‐pump surgery. We performed a post hoc analysis of the CORONARY (Coronary Artery Bypass Grafting [CABG] Off or On Pump Revascularization) trial, involving 4623 patients. The primary outcome was all‐cause readmission, and the secondary outcome was cardiac readmission. Cox models were used to investigate the association of outcomes with sex and off‐pump surgery. Hazard function for sex was studied over time using a flexible, fully parametric model, and time‐segmented analyses were performed accordingly. Rho coefficient was calculated for the correlation between readmission and long‐term mortality. Median follow‐up was 4.4 years (interquartile range, 2.9–5.4 years). The cumulative incidence rates of all‐cause and cardiac readmission were 29.4% and 8.2% at 5 years, respectively. Off‐pump surgery was not associated with either all‐cause or cardiac readmission. The hazard for all‐cause readmission in women over time was constantly higher than the hazard for men (hazard ratio [HR], 1.21 [95% CI, 1.04–1.40]; P=0.011). Time‐segmented analyses confirmed the higher risk for all‐cause (HR, 1.21 [95% CI, 1.05–1.40]; P<0.001) and cardiac (HR, 1.26 [95% CI, 1.03–1.69]; P=0.033) readmission in women after the first 3 years of follow‐up. All‐cause readmission was strongly correlated with long‐term all‐cause mortality (Rho, 0.60 [95% CI, 0.48–0.66]), whereas cardiac readmission was strongly correlated with long‐term cardiovascular mortality (Rho, 0.60 [95% CI, 0.13–0.86]). Readmission rates are substantial at 5 years after coronary artery bypass grafting and are higher in women but not with off‐pump surgery. URL: http://www.clinicaltrials.gov/; Unique identifier: NCT00463294.